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1.
Rev Panam Salud Publica ; 43: e63, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31410087

RESUMO

This paper presents results from the mammography quality plan of the National Breast Cancer Program at Argentina's National Cancer Institute, which focused on improving mammography quality in the public health-care sector and on using mammography to implement breast cancer screening. Plan implementation started in 2011, based on the premise that poor quality mammography impedes early diagnosis of breast cancer. At the time, there was little awareness in Argentina of the importance of quality control, and constant changes in lines of authority in the health system tended to hinder organized implementation of the program. The plan consisted of quality review and control of mammography facilities, training of technical and medical human resources, and implementation of an accreditation system for mammography services by the National Cancer Institute. Perception by involved personnel of the importance of quality improved; an overview was obtained of the state of mammography at the national level regarding quality, technology, quantity of equipment, and opportunities for implementation of screening; technical and medical personnel were trained using different methods; and standardization of mammography reading was promoted in the participating provinces.

2.
Lancet Oncol ; 20(9): e503-e521, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395473

RESUMO

Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging in the Caribbean because of the geographical spread of the islands, the frequently under-resourced health-care systems, and the absence of a cohesive approach to cancer control. In many Caribbean countries and territories, cancer surveillance systems are poorly developed, advanced disease presentations are commonplace, and access to cancer screening, diagnostics, and treatment is often suboptimal, with many patients with cancer seeking treatment abroad. Capacity building across the cancer-control continuum in the region is urgently needed and can be accomplished through collaborative efforts and increased investment in health care and cancer control.

3.
Lancet Oncol ; 20(9): e535-e548, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395475

RESUMO

Cancer is a leading cause of death in small island nations and is forecast to increase substantially over the coming years. Governments, regional agencies, and health services of these nations face daunting challenges, including small and fragile economies, unequal distribution of resources, weak or fragmented health services, small population sizes that make sustainable workforce and service development problematic, and the unavailability of specialised cancer services to large parts of the population. Action is required to prevent large human and economic costs relating to cancer. This final Series paper highlights the challenges and opportunities for small island nations, and identifies ways in which the international community can support efforts to improve cancer control in these settings. Our recommendations focus on funding and investment opportunities to strengthen cancer-related health systems to improve sharing of technical assistance for research, surveillance, workforce, and service development, and to support small island nations with policy changes to reduce the consumption of commodities (eg, tobacco and unhealthy food products) that increase cancer risk.

4.
Salud Publica Mex ; 61(4): 456-460, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31430087

RESUMO

Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.

5.
Artigo em Espanhol | PAHO-IRIS | ID: phr-51393

RESUMO

[RESUMEN]. Se presentan los resultados del Plan de calidad en mamografía del Programa Nacional del Cáncer de Mama del Instituto Nacional del Cáncer de la República Argentina, enfocado en mejorar la calidad de la mamografía en el sector público de salud e implementar el tamizaje de cáncer de mama por este método diagnóstico. El Plan se comenzó a ejecutar en 2011 con base en la premisa de que una mamografía de mala calidad impide el diagnóstico temprano del cáncer de mama. En ese momento, en Argentina existía poca conciencia sobre la importancia de los controles de calidad, y los continuos cambios en los niveles jerárquicos del sistema de salud tendían a obstaculizar el desarrollo organizado del programa. El Plan consistió en la revisión y el control de calidad de las instalaciones de mamografía, la capacitación de recursos humanos técnicos y médicos y la puesta en marcha de un sistema de acreditación de los servicios de mamografía por parte del Instituto Nacional del Cáncer. La percepción de la importancia de la calidad en el personal involucrado ha mejorado y se obtuvo un panorama general del estado de la mamografía a nivel nacional en cuanto a la calidad, la tecnología, la cantidad de equipos y las posibilidades de implementación del tamizaje. Se capacitó al personal técnico y médico mediante el uso de diferentes metodologías y se impulsó la unificación de la lectura mamográfica en las provincias intervinientes.


[ABSTRACT]. This paper presents results from the mammography quality plan of the National Breast Cancer Program at Argentina’s National Cancer Institute, which focused on improving mammography quality in the public healthcare sector and on using mammography to implement breast cancer screening. Plan implementation started in 2011, based on the premise that poor quality mammography impedes early diagnosis of breast cancer. At the time, there was little awareness in Argentina of the importance of quality control, and constant changes in lines of authority in the health system tended to hinder organized implementation of the program. The plan consisted of quality review and control of mammography facilities, training of technical and medical human resources, and implementation of an accreditation system for mammography services by the National Cancer Institute. Perception by involved personnel of the importance of quality improved; an overview was obtained of the state of mammography at the national level regarding quality, technology, quantity of equipment, and opportunities for implementation of screening; technical and medical personnel were trained using different methods; and standardization of mammography reading was promoted in the participating provinces.


[RESUMO]. São apresentados os resultados do Plano de qualidade em mamografia do Programa Nacional do Câncer de Mama do Instituto Nacional do Câncer da República Argentina, com o objetivo de melhorar a qualidade da mamografia na rede pública de saúde e implementar a prevenção do câncer de mama por este método diagnóstico. O Plano foi implementado em 2011 baseado na premissa de que a mamografia de má qualidade impede o diagnóstico precoce do câncer de mama. Havia, naquele momento na Argentina, pouca conscientização sobre a importância do controle de qualidade e as constantes mudanças na hierarquia do sistema de saúde eram um obstáculo ao desenvolvimento organizado do programa. O Plano compreendeu a avaliação e o controle de qualidade das instalações para mamografia, a capacitação do pessoal médico e técnico e a implantação de um sistema de credenciamento pelo Instituto Nacional do Câncer dos serviços de mamografia. Houve melhora na percepção da importância da qualidade entre o pessoal envolvido e se obteve um panorama geral da situação da mamografia ao nível nacional quanto à qualidade, recursos tecnológicos, volume de equipamentos e possibilidades de implementação do programa de prevenção. Foi realizada a capacitação do pessoal médico e técnico com o uso de diferentes metodologias e incentivada a uniformização da leitura mamográfica nas províncias consideradas.


Assuntos
Mamografia , Neoplasias da Mama , Garantia da Qualidade dos Cuidados de Saúde , Acreditação , Argentina , Mamografia , Neoplasias da Mama , Garantia da Qualidade dos Cuidados de Saúde , Acreditação , Neoplasias da Mama , Garantia da Qualidade dos Cuidados de Saúde , Acreditação
6.
Rev Panam Salud Publica ; 43: e55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31171925

RESUMO

Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)-now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual's capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.

8.
Artigo em Inglês | PAHO-IRIS | ID: phr-51069

RESUMO

[ABSTRACT]. Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)—now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual’s capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.


[RESUMEN]. Los países del Caribe están experimentando transiciones sociales, epidemiológicas y demográficas como resultado del envejecimiento de la población y el aumento de la prevalencia de las enfermedades no transmisibles (ENT), que en la actualidad causan el 78% de todas las defunciones. Estas circunstancias exigen replantear el modelo de atención para mejorar los resultados de salud y establecer sistemas de salud más sostenibles mediante nuevos enfoques en políticas, prestación de servicios, organización, capacitación, tecnología y financiamiento. Las políticas deben tener como propósito procurar una vida saludable, aprovechando las intervenciones que garanticen el envejecimiento saludable. El sistema de salud debe ser proactivo, estructurando las intervenciones para reducir la incidencia de nuevos casos de ENT y para prevenir las complicaciones relacionadas. Las intervenciones deben centrarse en optimizar la capacidad funcional, la autonomía y el desenvolvimiento general de la persona dentro de un entorno adaptado y con el apoyo necesario del sistema de salud en materia de atención preventiva, cuidados a largo plazo, de autocuidado y de atención en la comunidad.


[RESUMO]. Os países do Caribe estão passando por transições sociais, epidemiológicas e demográficas configuradas pela população de idosos cada vez maior e a ascensão das doenças não transmissíveis (DNTs), já responsáveis por 78% de todas as mortes. Essas circunstâncias exigem repensar o modelo de atenção para melhorar os desfechos de saúde e construir sistemas de saúde mais sustentáveis, com novas orientações de política, prestação de serviços, organização, treinamento, tecnologia e financiamento. As políticas devem ser orientadas para a vida saudável, alavancando intervenções que asseguram o envelhecimento saudável. O sistema de saúde deve estruturar proativamente intervenções para reduzir a incidência de novos casos de DNT e a prevenir as complicações relacionadas. As intervenções devem se concentrar na otimização da capacidade do indivíduo, das habilidades funcionais e da autonomia dentro de ambientes adaptados, e também nas ações preventivas a para assistência de longa duração, no autocuidado, na atenção na comunidade e no apoio pelos sistemas de saúde.


Assuntos
Sistemas de Saúde , Envelhecimento , Doenças não Transmissíveis , Aruba , Curaçao , Sistemas de Saúde , Envelhecimento , Doenças não Transmissíveis , Sistemas de Saúde , Envelhecimento , Doenças não Transmissíveis , Curaçao
9.
Salud pública Méx ; 60(6): 683-692, Nov.-Dec. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1020933

RESUMO

Abstract: Objective: To describe HPV vaccine program implementation, monitoring and evaluation experiences in Latin America. Materials and methods: We reviewed published articles in peer-reviewed journals and reports from government websites, as well as the PAHO/WHO/UNICEF Joint Reporting form and the ICO/IARC HPV Information Centre database. Results: By December 2016, 13 countries/territories in Latin America (56%) have introduced HPV vaccines. The majority have done so in the past three years, targeting 10-12 year old girls with a two dose schedule, through school programs. Vaccine coverage ranges from 30 to 87%. Safety monitoring is well established, but monitoring vaccine impact is not, and data are not available. Conclusions: Although Latin America is the most advanced developing region with HPV vaccine introduction, systems for its monitoring are weak and there is a paucity of consistently available coverage data for this vaccine. Challenges remain to introduce HPV vaccines in several countries, to achieve high coverage, and to strengthen monitoring, evaluation and reporting.


Resumen: Objetivo: Describir las experiencias con la implementación, monitoreo y evaluación de programas de vacunación contra VPH en América Latina. Material y métodos: Revisamos datos publicados en revistas, informes gubernamentales, así como los informes de monitoreo de programas de inmunizaciones de la OPS/OMS/UNICEF y del centro de información del VPH del ICO/IARC. Resultados: Hasta diciembre de 2016, 13 países/territorios en América Latina (56%) han introducido vacunas contra VPH. La mayoría lo han hecho en los últimos tres años, apuntando a niñas de 10 a 12 años con un calendario de dos dosis, a través de programas escolares. La cobertura de vacunas varía entre 30 y 87%. La vigilancia de la seguridad está bien establecida, pero el monitoreo del impacto de la vacuna no, y los datos no están disponibles. Conclusiones: Aunque América Latina es la región en desarrollo más avanzada en la introducción de la vacuna contra VPH, los sistemas para su monitoreo son débiles y hay una escasez de datos de cobertura disponibles. Sigue habiendo desafíos para introducir vacunas contra VPH en varios países, para lograr una alta cobertura y para fortalecer el monitoreo, la evaluación y la presentación de informes.

10.
Cost Eff Resour Alloc ; 16(Suppl 1): 53, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30455612

RESUMO

Decision making in health requires the use of sound evidence and context-specific information, guided by a priority setting methodology or framework. For noncommunicable disease (NCD) prevention and control, a decision-making methodology has been applied by the World Health Organization to delineate priorities, and options for cost-effective NCD interventions. A set of 14 interventions considered very cost-effective, affordable and feasible for implementation in various resource level settings were identified. Among them, tobacco control through taxation, bans on tobacco advertising, plain packaging, and smoke free public spaces stands out as perhaps the single most important interventions to tackle NCDs.

11.
J Glob Oncol ; 4: 1-7, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30241140

RESUMO

Breast cancer is the most common cancer in women worldwide, affecting > 1.6 million women each year, projected to increase to 2.2 million cases annually by 2025. A disproportionate number of the > 500,000 women who die as a result of breast cancer each year reside in low-resource settings. Breast cancer control is an important component of cancer control planning and women's health programs, and tools are needed across the care continuum to reduce the cancer burden, especially in low-resource settings. Cancer control planning is complex and multifaceted. Evidence shows that outcomes are improved when prevention, early diagnosis, treatment, and palliation are integrated and synchronously developed within a country/region's health plan. The Knowledge Summaries for Comprehensive Breast Cancer Control are the product of a multiyear collaboration led by the Union for International Cancer Control, Breast Health Global Initiative, Pan American Health Organization, and Center for Global Health of the US National Cancer Institute. Fourteen knowledge summaries distilled from evidence-based, resource-stratified guidelines, and aligned with WHO guidance on breast cancer control, build a framework for resource prioritization pathways and delivery systems for breast cancer control at four levels of available resources: basic, limited, enhanced, and maximal. Each summary contains relevant content to inform breast cancer policy, clinical care, and advocacy, aiding in the development and implementation of policies and programs. These tools provide a common platform for stakeholders, including policymakers, administrators, clinicians, and advocates to engage in decision making appropriate to their local setting. The goal is to facilitate evidence-based policy actions and urgently advance implementation of an integrated approach to reduce breast cancer mortality and improve quality of life.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Terapia Combinada , Assistência à Saúde , Detecção Precoce de Câncer , Feminino , Acesso aos Serviços de Saúde , Humanos , Programas de Rastreamento , Prognóstico , Fatores de Risco , Comportamento de Redução do Risco
12.
J Glob Oncol ; 4: 1-11, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30241245

RESUMO

According to the Pan American Health Organization, noncommunicable diseases, including cancer, are the leading causes of preventable and premature death in the Americas. Governments and health care systems in Latin America face numerous challenges as a result of increasing morbidity and mortality from cancer. Multiple international organizations have recognized the need for collaborative action on and technical support for cancer research and control in Latin America. The Center for Global Health at the US National Cancer Institute (NCI-CGH) is one entity among many that are working in the region and has sought to develop a strategy for working in Latin America that draws on and expands the collaborative potential of engaged, skilled, and diverse partners. NCI-CGH has worked toward developing and implementing initiatives in collaboration with global partners that share the common objectives of building a global cancer research community and translating research results into evidence-informed policy and practice. Both objectives are complementary and synergistic and are additionally supported by an overarching strategic framework that is focused on partnerships and science diplomacy. This work highlights the overall strategy for NCI-CGH engagement in Latin America through partnerships and diplomacy, and highlights selected collaborative efforts that are aimed at improving cancer outcomes in the region.


Assuntos
Diplomacia , Cooperação Internacional , Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Pesquisa , Animais , Financiamento de Capital , Saúde Global , Planejamento em Saúde , Humanos , América Latina/epidemiologia , Vigilância em Saúde Pública , Pesquisa/economia , Pesquisa/legislação & jurisprudência , Pesquisa/organização & administração
13.
Salud Publica Mex ; 60(6): 683-692, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30699273

RESUMO

OBJECTIVE: To describe HPV vaccine program implementation, monitoring and evaluation experiences in Latin America. MATERIALS AND METHODS: We reviewed published articles in peer-reviewed journals and reports from government web- sites, as well as the PAHO/WHO/UNICEF Joint Reporting form and the ICO/IARC HPV Information Centre database. RESULTS: By December 2016, 13 countries/territories in Latin America (56%) have introduced HPV vaccines. The majority have done so in the past three years, targeting 10- 12 year old girls with a two dose schedule, through school programs. Vaccine coverage ranges from 30 to 87%. Safety monitoring is well established, but monitoring vaccine impact is not, and data are not available. CONCLUSIONS: . Although Latin America is the most advanced developing region with HPV vaccine introduction, systems for its monitoring are weak and there is a paucity of consistently available coverage data for this vaccine. Challenges remain to introduce HPV vaccines in several countries, to achieve high coverage, and to strengthen monitoring, evaluation and reporting.


Assuntos
Programas de Imunização , Vacinas contra Papillomavirus , Vacinação/estatística & dados numéricos , Criança , Detecção Precoce de Câncer , Monitoramento Epidemiológico , Feminino , Humanos , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , América Latina/epidemiologia , Masculino , Vacinas contra Papillomavirus/administração & dosagem , Vacinas contra Papillomavirus/efeitos adversos , Utilização de Procedimentos e Técnicas , Avaliação de Programas e Projetos de Saúde , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle
14.
Artigo em Inglês | PAHO-IRIS | ID: phr-34505

RESUMO

[ABSTRACT]. Despite its low incidence, pediatric cancer makes up a significant portion of childhood illnesses. Yet information on pediatric cancer in Latin America is scarce. Since the early 2000s the World Health Organization (WHO) has been highlighting the role of cancer registries in cancer surveillance and control. This article describes the main aspects of pediatric cancer registration in Latin America, highlighting the successes of Argentina’s national pediatric cancer registry, Registro Oncopediátrico Hospitalario Argentino (ROHA), which allows for better health care and contributes to improved outcomes for children with cancer, to provide a rationale for the expansion and enhancement of pediatric cancer registration in other Latin American countries.


[RESUMEN]. A pesar de tener una incidencia baja, el cáncer pediátrico representa una proporción significativa de las enfermedades de la niñez. Sin embargo, en América Latina hay poca información al respecto. Desde comienzos del siglo XXI, la Organización Mundial de la Salud (OMS) ha puesto de relieve la función que tienen los registros oncológicos en la vigilancia y el control del cáncer. En este artículo se describen los principales aspectos de los registros de cáncer pediátrico en América Latina y se pone el acento en los éxitos del Registro Oncopediátrico Hospitalario Argentino (ROHA), que permite mejorar la atención de salud y ayuda a obtener mejores resultados en los niños con cáncer, lo cual puede servir de fundamento para la ampliación y el perfeccionamiento de los registros de cáncer pediátrico en otros países latinoamericanos.


[RESUMO]. Apesar da incidência baixa, o câncer em crianças representa uma parcela considerável das afecções infantis. Porém, existem poucos dados sobre o câncer em crianças na América Latina. Desde o princípio dos anos 2000, a Organização Mundial da Saúde (OMS) trabalha para reforçar o papel dos registros de câncer no controle e vigilância da doença. Este artigo examina as principais características dos registros do câncer em crianças na América Latina e põe em relevo os bons resultados obtidos com o registro nacional da Argentina (Registro Oncopediátrico Hospitalario Argentino, ROHA), como melhoria da assistência de saúde e dos desfechos aos pacientes pediátricos, servindo de base para a ampliação e o aperfeiçoamento do registro de câncer em crianças em outros países latino-americanos.


Assuntos
Serviços de Saúde da Criança , Neoplasias , Vigilância , América Latina , Argentina , Serviços de Saúde da Criança , Neoplasias , Vigilância , América Latina , Serviços de Saúde da Criança , Vigilância
15.
J Glob Oncol ; 3(5): 635-657, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29094101

RESUMO

Purpose: To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. Methods: ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Results: Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Recommendations: Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki.It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines.

16.
Cancer Causes Control ; 28(11): 1251-1263, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28917021

RESUMO

PURPOSE: To examine the factors associated with gynecologic cancer mortality risks, to estimate the mortality-to-incidence rate ratios (MIR) in Trinidad and Tobago (TT), and to compare the MIRs to those of select countries. METHODS: Data on 3,915 incident gynecologic cancers reported to the National Cancer Registry of TT from 1 January 1995 to 31 December 2009 were analyzed using proportional hazards models to determine factors associated with mortality. MIRs for cervical, endometrial, and ovarian cancers were calculated using cancer registry data (TT), GLOBOCAN 2012 incidence data, and WHO Mortality Database 2012 data (WHO regions and select countries). RESULTS: Among the 3,915 incident gynecologic cancers diagnosed in TT during the study period, 1,795 (45.8%) were cervical, 1,259 (32.2%) were endometrial, and 861 (22.0%) were ovarian cancers. Older age, African ancestry, geographic residence, tumor stage, and treatment non-receipt were associated with increased gynecologic cancer mortality in TT. Compared to GLOBOCAN 2012 data, TT MIR estimates for cervical (0.49 vs. 0.53), endometrial (0.61 vs. 0.65), and ovarian cancers (0.32 vs. 0.48) were elevated. While the Caribbean region had intermediate gynecologic cancer MIRs, MIRs in TT were among the highest of the countries examined in the Caribbean region. CONCLUSIONS: Given its status as a high-income economy, the relatively high gynecologic cancer MIRs observed in TT are striking. These findings highlight the urgent need for improved cancer surveillance, screening, and treatment for these (and other) cancers in this Caribbean nation.


Assuntos
Neoplasias dos Genitais Femininos/epidemiologia , Adulto , Idoso , Grupos Étnicos , Feminino , Neoplasias dos Genitais Femininos/etnologia , Humanos , Incidência , Pessoa de Meia-Idade , Sistema de Registros , Trinidad e Tobago/epidemiologia , Trinidad e Tobago/etnologia
17.
Int J Gynaecol Obstet ; 138 Suppl 1: 57-62, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28691332

RESUMO

Both human papillomavirus (HPV) vaccination and screening/treatment are relatively simple and inexpensive to implement at all resource levels, and cervical cancer screening has been acknowledged as a "best buy" by the WHO. However, coverage with these interventions is low where they are needed most. Failure to launch or expand cervical cancer prevention programs is by and large due to the absence of dedicated funding, along with a lack of recognition of the urgent need to update policies that can hinder access to services. Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable program resources. There is significant momentum for expanding coverage of HPV vaccination and screening/preventive treatment in low-resource settings as evidenced by new global partnerships espousing this goal, and the participation of groups that previously had not focused on this critical health issue.


Assuntos
Implementação de Plano de Saúde , Programas de Rastreamento , Vacinas contra Papillomavirus/provisão & distribução , Defesa do Paciente , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/estatística & dados numéricos , Detecção Precoce de Câncer , Feminino , Saúde Global , Política de Saúde , Humanos , Parcerias Público-Privadas , Saúde da Mulher
18.
Rev Panam Salud Publica ; 41: e41, 2017 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-28614466

RESUMO

Objective: To characterize high-risk human papillomavirus (HPV) infections in a sample of women in two small English-speaking Caribbean countries: Saint Kitts and Nevis and Saint Vincent and the Grenadines. Methods: Sexually active women ≥ 30 years old attending primary care health facilities participated in the study. Each participant had a gynecological examination, and two cervical specimens were collected: (1) a specimen for a Papanicolaou (Pap) test and (2) a sample of exfoliated cervical cells for HPV DNA testing, using the HPV High Risk Screen Real-TM (Sacace). High-risk HPV genotypes were assessed in 404 women in Saint Kitts and Nevis and 368 women in Saint Vincent and the Grenadines. Results: High-risk HPV was detected in 102 of 404 (25.2%) in Saint Kitts and Nevis and in 109 of 368 (29.6%) in Saint Vincent and the Grenadines. High-risk HPV genotypes 52, 35, 51, 45, and 31 were the most common high-risk types in Saint Kitts and Nevis. In Saint Vincent and the Grenadines, the most common high-risk HPV genotypes were 45, 35, 31, 18, and 51. Current age was found to be significantly associated with high-risk HPV infection in both countries. In addition, in Saint Vincent and the Grenadines, high parity (> 3 pregnancies) and having had an abnormal Pap smear were found to be independent risk factors for high-risk HPV. Conclusions: These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean. Use of the study's results to guide the development of policy regarding implementation of HPV testing as the primary screening modality for older women is recommended.


Assuntos
Infecções por Papillomavirus/epidemiologia , Adulto , Idoso , Colo do Útero/virologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Prevalência , Medição de Risco , São Cristóvão e Névis/epidemiologia , São Vicente e Granadinas/epidemiologia , Esfregaço Vaginal
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